PAMA Resource Center

As of January 1, 2019, CMS will implement a new regulation – section 218 of Protecting Access to Medicare Act (PAMA) – which will change the ordering process for certain advanced diagnostic imaging studies.

Section 218 of PAMA Highlights:

  • Establishes the use of Appropriate Use Criteria (AUC) for advanced diagnostic imaging studies. AUC is defined as “criteria that are evidence-based (to the extent feasible) and assist professionals who order and furnish applicable imaging services to make the most appropriate treatment decisions for a specific clinical condition.”
  • For hospitals and radiologists to be reimbursed, they must document that AUC was consulted, similar to the current process for prior authorizations.
  • Covers all MR, CT, PET, and nuclear medicine tests for:
    • Outpatients
    • Emergency Department patients (exceptions for qualified emergencies)
    • Any patient in observation or outpatient status
  • The regulation excludes radiology testing for all inpatients, but input is being gathered to have one process to order advanced imaging that is consistent for both inpatients and outpatients.To prepare for the mandate, Munson Healthcare (MHC) is working with the National Decision Support Company to connect these criteria to our current medical record. 

Please continue to watch this page for updates, education, and resources related to the implementation of PAMA.

Helpful Websites

CMS-PAMA Regulations